Parent Verification of Information Transferred Through the IRS Data Retrieval Process

FAXXS40E

245 College Road, Smithfield, NC 27577
(919) 209-2036 | www.JohnstonCC.edu Dependent Student
IRS Non-Transfer

Parent Verification of Information Transferred Through the IRS Data Retrieval Process (Dependent Student Parent Signature and PIN Number Verification)

Please note:
The supplied PIN number must match the number on file associated with the student's form to represent the parent signature.

Parent Signature
Student ID Number
Dependent Supplied
PIN Number
Date

By checking this box, I ratify the use of my typed name and attached PIN number as an electronic representation of my signature.